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Steven Peskin MD's blog

Contributing Voices
Steven Peskin, MD
Steven Peskin, MD

Three days of a severe headache that would not respond to the ibuprofen, naproxen, or acetaminophen. "I never get headaches" is what I said multiple times to my wife and to colleagues. The morning of day three, a rash started to appear on my forehead, in the left eyebrow, in the scalp, with swelling around the left eye and swollen lymph nodes at the angle of the jaw on the left. My wife mentioned "shingles". Poor early diagnosis on my part, and, I said "Oh !*#%! that is what I have".  I was starting to feel as if I had been taken out by an NFL linebacker.

Contributing Voices
Steven Peskin, MD

"Welcome to Moe's"  is the warm and friendly greeting of the staff at one of my favorite cantinas — Moe's Southwest Grill, where a rice bowl and iced tea set me back just $9 and change. But for one woman who underwent Mohs surgery for a very minor lesion that may not have required the Mohs procedure and the subsequent plastic surgery repair, her bill for the day was over $25,000, as reported in a January 18, 2014 New York Times article titled "Patients' Costs Skyrocket; Specialists' Incomes Soar".

In the article, the Times journalist Elizabeth Rosenthal notes:

"Use of the surgery has skyrocketed in the United States — over 400 percent in a little over a decade — to the point that last summer Medicare put it at the top of its “potentially misvalued” list of overused or overpriced procedures. Even the American Academy of Dermatology agrees that the surgery is sometimes used inappropriately"

In this instance, the patient, a professor at the University of Central Arkansas, pushed back on the $25,000-plus charges, and, after months of wrangling, Baptist Health Medical Center reduced the bill to around $5,000, with the largest component of the reduction being the plastic surgeon's fee -- from $14,407 to $1,375 (Still a nice paycheck for what was likely less than an hour of time!).

The patient subsequently went to a dermatologist at the University of Arkansas who said that she likely did not need "such an extensive procedure." The patient's final comment in the article: "It was like, "Take your purse out, we're robbing you'"

Welcome to Mohs!

Steven R. Peskin, MD, MBA, FACP, is associate clinical professor of medicine at the University of Medicine and Dentistry of New Jersey – Robert Wood Johnson Medical School, and is governor of the American College of Physicians, New Jersey South.

Contributing Voices
Steven Peskin, MD

The memory tape of the golden oldie from Lovin' Spoonful was playing in my head before watching Dr. Eric Topol’s interview with Dr. Paul Offit about his recently published book, Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine

The book tackles with rigor and vigor the lack of evidence for assertions and testimonials made by celebrity physicians, politicians, and stars of the small and big screen regarding the benefits for megadoses of vitamins, various nutraceuticals, and misuse of FDA-approved drugs, such as prolonged IV antibiotics for chronic Lyme Disease. Indeed, some of these may actually harm the person.

To me, the most fascinating part of this debunking of pseudo-science is the power of the placebo. Offit acknowledges the ability of the human being to heal itself. Through the connection of mind and body and conscious or unconscious thought affecting neurobiological or neurohormonal up or down regulation, we have remarkable abilities to positively or negatively impact our immune system, our perception of pain, blood circulation, digestion, and other vital functions that may profoundly help or harm our health and well being.

Just as the vaccines stimulate an immune response that prepares the body to defend itself from a viral or bacterial attack, we have the ability to autoregulate in other ways to heal ourselves. Not magic, but magical!

Steven R. Peskin, MD, MBA, FACP, is associate clinical professor of medicine at the University of Medicine and Dentistry of New Jersey – Robert Wood Johnson Medical School, and is governor of the American College of Physicians, New Jersey South.

Contributing Voices
Steven Peskin, MD

In doing research for a Grand Rounds needs assessment on humanism in medicine, I re-acquainted myself with a classic lecture by Dr. Francis Peabody, "The Care of the Patient" published in the Journal of the American Medical Association. (Peabody, FW: The Care of the Patient. JAMA 1927; 88:877–882.)

The words that Peabody spoke to his students in 1927, as Peabody himself faced his own mortality, having been diagnosed with cancer at age 45, are resonant and worthy of daily reminder for any of us involved in caring for patients, designing care models, influencing benefit plans, organizing systems of care, integrating technology into patient care, or serving in adminstrative leadership.

“Medicine is not a trade to be learned, but a profession to be entered,” he told his students. “The treatment of a disease may be entirely impersonal; the care of a patient must be completely personal.... the secret of the care of the patient is in caring for the patient.”

Steven R. Peskin, MD, MBA, FACP, is associate clinical professor of medicine at the University of Medicine and Dentistry of New Jersey – Robert Wood Johnson Medical School, and is governor of the American College of Physicians, New Jersey South.

Contributing Voices
Steven Peskin, MD

At a recent Grand Rounds, a leading clinician medical ethicists told of a meeting with members of the family of a critically ill 6 week old boy who had been in a neonatal intensive care unit since birth. At the meeting were the mother and father, both sets of grandparents, an and aunt and uncle, three members of the hospital ethics committee and physicians and nurses who were caring for the seriously ill child. The one question that our speaker posed to the parents and any other family members that chose to offer a response:

"For what do you hope for your son/ grandson/ nephew?" 

Contributing Voices
Steven Peskin, MD

Alice found a Wonderland.

What we found last week, when the Center for Medicare & Medicaid Services (CMS) released cost information for the 100 most common diagnoses and procedures in over 3,000  hospitals, is beyond Alice’s imagination. Some of the cost differences for the identical billing diagnoses qualify for “you cannot make this stuff up.”

Two examples:

Contributing Voices
Steven Peskin, MD

We know Watson, the supercomputer, for its vast fund of knowledge and thinking prowess when machine bested man, defeating the all-time Jeopardy champ for games won, Ken Jennings (74), and Brad Rutter, Jeopardy’s highest money winner ($3,470,102), and winning against Jennings in a head-to-head Tournament of Champions. Now, Watson is flexing her considerable problem-solving muscle in medicine, and, more specifically, in clinical decision support.

Contributing Voices
Steven Peskin, MD

Earlier today, I was speaking with a physician colleague about his commitment to continue to improve person-centered care in his primary care practice and to enhance patient experience. We talked about the potential value of greeters in the practice, of a patient council to offer feedback and recommendations, and, with training, increasing the scope of service of medical assistants to allow nurses, advanced practice nurses, and physicians to spend more time with more complex care.

Contributing Voices
Steven Peskin, MD

In April of last year, I wrote about the first release of recommendations from the American Board on Internal Medicine Foundation in conjunction with nine medical societies as part of a campaign: Choosing Wisely. The campaign aims to draw attention to and call into question commonly ordered tests like chest x-rays before surgery, frequently performed procedures like colonoscopies, and frequently prescribed treatments like antibiotics for upper respiratory infections.

Contributing Voices
Steven Peskin, MD

With apologies to James Taylor, I was recently introduced to a UNC-Chapel Hill professor of psychology, Dr. Edwin Fisher, from my alma mater and the university where the famous singer/ songwriter's father was dean of the School of Medicine. The work that Dr. Fisher is doing under the aegis of the American Academy of Family Physicians Foundation is on target for the Triple Aim.

Peers for Progress, designs, implements, and evaluates peer coach or peer educator programs worldwide. There are ample examples of successful and established programs led or facilitated by peer coaches, motivators, educators, or others, including Alcoholics Anonymous, Mended Hearts, and Weight Watchers. Peers for Progress is building a global network of peer-support organizations that are making a difference in the health of and lives of people affected by a range of health problems and their associated impact on the individual and on communities.

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